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solved by the action of the acids of that organ; at other timesthey make their way to some part of the body, where at alater day they may prove the source of much mischief.

Catherine W---, aged eight years, was admitted intoDorcas ward, on February 29th, 1856. She has usually en-joyed good health. On the 13th of February, while playingwith another child, she fell against the stairs, and afterwardscomplained of her side. Her mother took her to a chemist;but being unable to pay him, he declined doing anything, andshe was brought to the hospital. Mr. Clark being there atthe time, he examined the child, and found a foreign body,supposed to be a pin or needle, underneath the skin, which itelevated over its point at each beat of the heart. It wassituated directly over the pericardium, being between thefourth and fifth ribs, and about opposite the junction of thebone and cartilage. He made a small incision through theskin, with the view of extracting it; but from the crying andstruggling of the child, he was unable to do so, and as it wascontinually moving about, it soon moved altogether out of reach.She was then ordered to have a poultice over the wound. Afterthis she was brought to the surgery; and, on one occasion,something was seen under the skin, as at first, but about aquarter of an inch higher up. On account of the incessantcrying and struggling of the child when touched, nothing wasdone; and two days before admission, an opening formed spon-taneously where the foreign body was last seen. There is nohistory of the child ever having swallowed a pin or needle. Onadmission the child was weak and emaciated; face pale andpasty; the openings discharging about half a pint of matterdaily; pulse 110, feeble, but quite regular; bowels regular;appetite bad. She does not seem to suffer much, and is gene-rally quiet, except when disturbed.March 1st.—Mr. Clark divided the portion of skin between

the two openings; but, after a careful search, nothing wasfound. The wound continues discharging as much as ever, thematter coming from the bottom of the wound almost continu-ously, and not varied by the action of the heart, or by expi-ration. Poultices to be continued, and search to be made tosee if anything comes away with the discharge. Ordered, halfa grain of quinine, with syrup of orange-peel, and infusion ofroses, twice a day. To have arrow-root, beef-tea, and twoounces of wine.2nd.-Much the same. Wine increased to four ounces; one

egg.4th.-Wound discharging as much as ever. She was sick

to-day, after eating a small piece of meat; face somewhatpuffy and oedematous; lips livid and congested; pulse 115,feeble, but regular. Mr. Clark suspected that the pericardiumwas affected, and that the matter was coming away from it.Wine increased to six ounces.7th.-Mr. Clapton examined her chest very carefully, and

found dulness on percussion on the left side, below the wound,and posteriorly and laterally, where there was large and irre-gular crepitation. There was dulness under the clavicle; thevocal resonance was much increased; and the lung was stillpermeated by a considerable quantity of air. Right lung reso-nant on percussion; breath-sounds exaggerated; she is breath-ing quickly, but not laboriously, and can bear to be raised inbed. She has some cough now, which has come on since shecame in, but no expectoration; does not complain of pain.Heart-sounds are healthy, and its action regular, but feeble;pulse 115; the dulness on percussion over the cardiac regiondoes not extend farther than natural on the right side; on theleft it is continuous with the dulness over the left lung.

10th.-Dr. Peacock examined the chest to-day, and found Ithe heart-sounds natural. The wound discharges as much as ever; she takes her wine and beef-tea, but is thinner andfeebler than on admission, and sleeps a good deal.

llth.-One P.M.: The wound ceased discharging this morn-ing, and she has taken nothing to eat or drink during the day.Breathing quick and short; pulse very quick and feeble ; facepale and anxious; she takes little notice of anything, exceptwhen spoken to, and cries when touched. She is evidentlymoribund. Four P.M.: She died quietly, without any altera-tion of the symptoms.

Autopsy.—On the following morning the chest was opened,and both lungs, together with the heart, were removed, andcareful search was made in the intercostal spaces and neigh-bouring parts, but no foreign body was found.-Heart : The peri-cardium was found adherent to the sternum and costal carti-

lages, and a probe passed obliquely from the external woundinto its cavity; it contained three or four ounces of pus, andwas considerably thickened; both its visceral and parietalportions were roughened, but there were no adhesions between

the two. On cutting into the heart, it was found healthyinternally.—Lungs : Left pleural cavity contained half a pintof turbid serum, with lymph floating in it; the surface of thelung was covered with a thickish coating of straw-colouredtenacious lymph; the opposite surfaces of the pleura were no-where adherent. The lung itself was solid, containing no airwhatever; it was of a darkish-red colour, and broke downreadily under pressure; it was somewhat diminished in bulk;the right lung exhibited slight traces of inflammation. All theparts were cut up into small pieces, and careful search madefor a foreign body, but without any being discovered.

MIDDLESEX HOSPITAL.

ENORMOUS MALIGNANT DISEASE OF THE KIDNEY IN A CHILD;ENLARGEMENT OF THE LEFT EXTREMITIES; DEATH; REMARK-ABLE CONDITION OF THE KIDNEY FOUND AT THE AUTOPSY,ITS WEIGHT BEING THIRTY-ONE POUNDS.

(Under the care of Dr. HAWKINS.)MEDULLARY CANCER, by far the most frequent malignant

disease to which children are liable, does not appear to be ofcommon occurrence as a primary affection of the kidney, andrarely acquires the size of the tumour here described. It istruly surprising that life should have been so prolonged, andthat with so little pain or general distress; for up to Septem-ber we see that the inconvenience to the patient was not suffi-cient to induce him to offer a complaint, and even at a laterperiod the functions of digestion, assimilation, &c., were in noway disturbed. It is true that emaciation was, from the first,progressive, but this is entirely accounted for by the largequantity of nutritious matter taken into the system beingappropriated to the development of the diseased growth. Thecase is one of many which show what an amount of pressurecan be borne by almost any viscus when submitted graduallyto its influence.The time at which the disease originated must, of course, be

a matter of conjecture. It is certainly unusual to find medullarycancer extending over a period of seven years; yet our know-ledge of the fact that it is far from uncommon for its develop-ment to be arrested for a time, and that occasionally for a veryconsiderable period, must preclude the idea of its congenitalorigin being looked upon as impossible.For the notes of the following case we are indebted to the

kindness of Mr. Barley Balding, surgical registrar to thehospital :-

J. B--, aged six years, admitted into the hospital onMay 29th, 1855, under the care of Dr. Hawkins.

History.—Born of healthy parents; is one of a family of tenchildren, of which five are now living, the others having diedof acute infantile diseases. When six weeks old, the mothernoticed that both left extremities were larger than the right;the skin was looser, and the muscles she,describes as being lessfirm than those of the opposite side. She was so struck withthe difference that she consulted a medical man about it. Atthree years of age the child had hooping-cough, and shortlyafter measles, but has never had scarlatina. The abdomen, themother believes, has always been rather larger than could beconsidered natural, but this has not been to a marked extent.With these exceptions, the child had fair health till the middleof April, 1855, (six weeks before admission,) when he was sud-denly seized with sickness, and from his appearance the motherbelieved him to be very ill, and though far better on the fol-lowing day, and so much so as to be able to walk out of thehouse, did not regain his appetite for about a week. Duringthis illness the mother accidentally discovered the tumour inthe upper part of the left side of the abdomen. It then ap-peared to be almost circular, and about two inches in diameter.It was not perceptible to the eye, but its lower margin couldbe distinctly felt; it was very hard, but not painful, nor didmoderate pressure cause any inconvenience. She believes thatit gradually increased in size after she first discovered it, tillshe brought the child to the hospital, and during this time shenoticed that he had quite regained his appetite, which had, infact, become voracious, and, though he appeared fatigued aftermoderate exercise, he was able to walk about without effort.

State on admission.-Rather emaciated; abdomen very muchswollen, especially on the left side, where the veins are en-larged and tortuous ; the left extremities are considerablylarger than the right, owing to the soft parts being much firmerand the muscles apparently better developed; there is, how-ever, no difference in length. Upon manipulation, a tumourcan be felt, of somewhat globular form, about three inches indiameter, occupying part of the left hypochondriac, left lumbar,

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and umbilical regions; its lower margin is well defined, but itsupper boundary cannot be ascertained; the dulness on percus-sion, which is complete over all parts of the tumour, beingthere continuous with that of the spleen. The patient eats,drinks, and sleeps well, is able to sit up the greater part of theday, walks frequently up and down-stairs, and does not com-plain of pain.August 1st.—Since admission, the tumour has fast increased

in size, and now extends half an inch below the umbilicus,and about the same distance to the right of the mesian line;the abdomen generally is much more swollen, and the veinsare much larger. The patient walks about the garden for anhour or two every day, and though taking a large quantity offood, and eating very frequently, is daily becoming more erna-ciated. He appears to suffer no inconvenience, except thatcaused by the bulk of the tumour, the large size of the abdomenbeing-such as to impede progression. He complains of thirst,and evinces a desire to drink frequently of cold water. Thebowels act with regularity; and the urine, which is frequentlyvoided, and in quantity rather above the natural standard,presents no abnormal appearances.The patient continued to go about till September, and to

walk up and down one flight of stairs to and from the wardwithout assistance. About the middle of the month, afterhaving spent some time in the garden of the hospital, he foundhimself unable to get back, and was then, for the first time,carried up-stairs. After this he was almost constantly confinedto his bed. The tumour gradually increased in size till his death;for some time previous to which, indistinct fluctuation could bedetected in some parts of it. The abdomen, about the middleof December, measured in circumference thirty-six inches,and, at the end of March, upwards of forty-two. For the lasttwo months, he suffered much from dyspnœa; and, for thelast three weeks, had constant orthopnoea, and daily increasingoedema of the left leg. His appetite, however, remainedinordinate till the last; and the bowels, which had continuedto act regularly till within a short time of his death, hadrecently become somewhat constipated. He sank gradually,and died April 7th, 1856.The accompanying sketch is from a photograph taken by

Mr. Heisch shortlv after death :--

Post-mortem examination, fifty four hours afterwards.—Thewhole of the abdomen, except the right inguinal region, wasoccupied by a large globular tumour, anteriorly firmly adherentto the parietes, and covered by peritoneum, posteriorly lying Iin contact with the psoas muscle; the small intestines werethrust down to the right inguinal region; the spleen and liverwere driven upwards into the thorax; the whole of the trans-verse colon was firmly adherent to the tumour ; and a portionof the descending colon, which ran along the front, was for ashort distance imbedded in it. The tumour, when removedfrom the body, was found to weigh thirty-one pounds. Tracesof kidney structure could be recognised as if spread out overthe entire substance; large masses of medullary cancer werevisible on its surface. Upon section, the centre was found tobe occupied by several pints of dark, thick fluid, floating inwhich were several fragments of the broken down cancerousmass; the more solid portions varied in consistence from thatof firm medullary cancer to gelatinous matter in a semi-fluidstate, large masses of it being found in every stage of dege-neration ; the kidney on the opposite side was much enlarged.No cancerous deposit was found in any of the other viscera. !

COLLEGIATE ELECTIONS.—The Council of the Collegeof Surgeons have just announced that a meeting of the Fellowsof the College will take place on Thursday, the 3rd proximo,for the election of four Fellows into the Council of the College,in the room of two members going out in rotation, and ofGeorge James Guthrie, Esq., a life member, and GeorgePilcher, Esq., an elective member. It is generally expectedthat the retiring members will be re-elected, and that thesuccessors of Messrs. Pilcher and Guthrie will be, EdwardCock, Esq., of Guy’s Hospital, and Samuel Solly, Esq., of St.Thomas’s Hospital.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, MAY 13TH, 1856.MR. CÆSAR HAWKINS, PRESIDENT.

THE RESULTS OF SOME INQUIRIES INTO THE CONDITION OF THEDEAF AND DUMB.

BY JOSEPH TOYNBEE, F.R.S., ,AURAL SURGEON TO ST. MARY’S HOSPITAL, CONSULTING AURAL SURGEON TO

THE ASYLUM FOR THE DEAF AND DCMB, AND LECTURER ON AURALSURGERY AT ST. MARY’S HOSPITAL MEDICAL SCHOOL.

THIS paper embraced the following points :-The diseasesproducing deaf-mutism ; the condition of the ears in the deafand dumb, as ascertained by examination during life ; the con-dition of the ear in the deaf and dumb, as revealed by dissec-tion ; the amount of hearing possessed by children educated asdeaf and dumb; the mode of examining a child supposed tobe deaf and dumb; the medical treatment of the ears of the deafand dumb. The facts adduced were the result of an analysisof the cases of 411 children examined in the asylum. Thatdivision of the paper which referred to the condition of the earin deaf-mutes, as revealed by dissection, was illustrated with aminute description of four dissections made by the author, andbv a tabular view of thirty-one others, made by various pre-ceding observers.

Dr. WEBSTER inquired of the author of the paper if he hadobserved whether deaf-mutism were more common in malesthan females, as his (Dr. Webster’s) experience led him tobelieve. The malady was more prevalent in hillv than in levelcountries. There were 10,314 deaf-mutes in England in 1851,or 1 in every 1738 of the population, the proportion in Scotlandbeing 1 in 1340; in Berne, in Switzerland, there was 1 in 200;in England and Wales the males numbered 121 to 100 females.He believed deaf-mutes rarely lived beyond 60 years. Formerlydeaf mutes, when at the age of three years, were destroyed asmonsters. He thought it probable that the wild men of thewoods, many curious instances of whom had been related, weredeaf-mutes, who had been deserted by their parents, andsought companionship amongst the lower animals. The maladywas greatly promoted by the degeneration of the human spe-cies ; it was hereditary, and intermarriages amongst deaf-muteswere therefore highly objectionable.

Dr. BABINGTON thought that deaf-mutism was frequentlyassociated with a scrofulous diathesis. He had known deaf-mutes intermarry, the offspring being sometimes subjects ofthe same deficiencies, and sometimes entirely free from them.He had known them reach the age of seventy, but as their-constitutions were generally weak, their lives were usually ofshort duration.

In reply to the President, Dr. BABINGTON remarked thatthe disease was not more prevalent in one class than another.Mr. BRODHURST had observed malformation of the fauces

in congenital cases.Mr. MOORE thought that the morbid appearances in the ear,

in some of the cases described, could not sufficiently accountfor deafness, and he asked if Mr. Toynbee had carried his exa-minations to the auditory nerve.

Dr. E. SMITH mentioned cases of three deaf-mutes in onefamily, all of whom lived beyond sixty years.

Dr. BABINGTON stated, that out of above 300 deaf-mutes atthe asylum, forty were the offspring of marriages between first-cousins.Mr. TOYNBEE replied, that as the asylum received only a,

certain number of boys and girls, and was always full, noreliable statistics could be obtained as to the comparative pre-valence of this disease in the sexes. It often resulted from themarriage of cousins, and was occasionally ascribed to the factof the pregnant mother seeing a deaf-mute. He himself knewan entire family of six or seven persons born deaf and dumb,neither of whose parents had seen a deaf-mute. He had notobserved any malformation of the fauces. Persons living invalleys were more liable to this disease than those who livedin elevated places.ON THE DIAGNOSIS OF CERTAIN FORMS OF INFECTING AND

NON-INFECTING SYPHILITIC SORES.

BY HENRY LEE, F.R.C.S.,SURGEON TO KING’S COLLEGE AND THR LOCK HOSPITALS.

The author observed that Jenner regarded a peculiar kind ofinflammation to be essential to the 7Droduction of the effects of